Female bodies are underrepresented in Cardiopulmonary Resuscitation (CPR) training. Most CPR dolls reflect only male torsos and do not conform to the shapes of the bodies of women. The lack of dolls bearing resemblance to bodies with breasts is so prolific that there has been a recent movement among companies supporting social justice and health equity to create breast attachments for flat-chested CPR dolls. The lack of representation of women’s bodies has dire real-world consequences for women experiencing Out-of-Hospital Cardiac Arrest (OHCA). In a 2017 study, researchers at the University of Pennsylvania found that men are more likely than women to receive CPR from a bystander at rates of staggering disparity- citizen rescuers provided CPR to 45% of men experiencing OHCA and only 39% of women experiencing OHCA. Men also experienced post-OHCA survivability rates that were 23% higher than post-OHCA survivability rates for women. This disparity means that women experiencing OHCA are more likely to die than men.
Such gender disparities illustrate an implicit bias and reluctance among citizen CPR rescuers to touch a woman’s breasts or remove her upper garments for appropriate CPR provision and Automated External Defibrillator (AED) pad placement. Researchers at the University of Colorado School of Medicine conducted a recent survey in which they asked respondents to provide reasons why they thought women experiencing a public cardiac event were less likely than men to receive bystander CPR. The most common responses included:
- Fears about physically harming a woman during CPR
- Fears of touching a woman innapropriately, or being accused of doing so
- Misconceptions that breasts make it difficult to perform CPR
- Misconceptions that women do not experience cardiac events or are more likely to exaggerate these events
If there is an underrepresentation of anatomically correct CPR dolls resembling the sexes, there is a significant underrepresentation of CPR dolls that equitably represent the natural skin tones of varying racial and ethnic groups. A quick online search of CPR training dolls or an interview with a CPR trainer will reveal that most CPR training dolls currently on the market are either toneless or pink. There is almost no realistic portrayal of the array of skin tones that a CPR rescuer might encounter when providing real-life CPR and lifesaving interventions to a real cardiac arrest victim.
For some minority communities, social determinants like socioeconomic status (SES) and access to education can mean that individuals with a low SES and less than a college-level education are less likely to be trained in CPR. A 2017 study of the Journal of the American Heart Association found that the older a person was and the less education they had meant that person was less likely to be trained in CPR, supporting the necessity to tailor CPR efforts to the needs of individual communities. A 2006 study showed that Black Americans experiencing OHCA are less likely to receive CPR from someone in their home than white Americans. The disparity was due to a lack of CPR training because of the limited availability of CPR courses in Black communities.
Bias Awareness and CPR Skills Education 